Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1477002384 |
---|---|
Provider Name | Molly Barbara Sheridan |
First Address | Baltimore, MD 21205-1506 |
Second Address | Baltimore, MD 21205-1506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2016 |
Last Update Date | 04/10/2016 |